Postmenopausal women with irritable bowel syndrome (IBS) have more severe symptoms than premenopausal women with IBS

Abstract

Background Although irritable bowel syndrome (IBS) is more common in women, little is known about the role of hormonal changes and menopause in IBS. This study aimed to evaluate for differences in gastrointestinal (GI) and psychological symptoms between pre‐ and postmenopausal women with IBS compared to age‐matched men with IBS. Methods Patients with Rome‐positive IBS were identified. Premenopausal women were <45 years of age with regular menses. Postmenopausal women were ≥45 years without menses for at least 1 year. Younger men were <45 years, and older men were ≥45 years. Questionnaires measured severity of IBS symptoms, somatic symptoms, health‐related quality of life (HRQOL), and psychological symptoms. Multivariable linear or logistic regressions evaluating relationships between age and sex were performed. Key Results 190 premenopausal women (mean age 30.25 years), 52 postmenopausal women (mean age 54.38 years), 190 men <45 years (mean age 30.45 years), and 52 men ≥45 years (mean age 53.37 years) were included. Postmenopausal IBS women had greater severity of IBS symptoms (P = .003) and worse physical HRQOL (P = .048) compared to premenopausal women. No differences were observed between age‐matched older and younger IBS men. Constipation increased with age for both sexes but was the principal IBS subtype in women only. Conclusions and Inferences Postmenopausal women with IBS have more severe IBS symptoms than premenopausal women, while no comparable age‐related changes were seen in IBS men. The modulatory effect of female sex hormones on brain‐gut interactions which affect visceral perception and GI function likely contributes to these findings.

Irritable bowel syndrome in midlife women: a narrative review

“…Researchers have linked sex hormones with gastrointestinal functions given compelling evidence showing a higher prevalence of IBS or functional dyspepsia symptoms and/or a greater symptom severity in women compared to men [ 18 – 22 ]. Although the underlying mechanisms linking sex hormones and gastrointestinal disturbances remain to be elucidated, intestinal dysmotility, visceral hypersensitivity, intestinal barrier dysfunction and mucosal immune activation through a brain-gut axis are thought to be involved [ 4 , 12 , 18 , 21 , 22 ]. For example, higher mucosal immune activation was found in women with IBS compared with men with IBS, and mast cell infiltration was related to greater abdominal bloating and dysmotility-like dyspepsia symptoms in women with IBS [ 23 ].…”

“…Multivariable analyses showed that younger age, lower estrogen levels and higher anxiety were predictive of an increase in severity of abdominal pain over time, while other sex hormones and menopause transition stages were not. In a cross-sectional study among women with IBS, Lenhart et al [ 4 ] found postmenopausal women with IBS ( n = 52, a mean age of 54.4 years) experienced significantly worse severity of overall IBS symptoms, physical health-related quality of life and depression than premenopausal women with IBS ( n = 190, a mean age of 30.2 years), but no differences in abdominal pain, bloating and somatic symptoms were observed. Of note, no difference in the severity of overall IBS symptoms was found between age-matched older and younger males with IBS and thus the authors suggested the potential modulatory effects of estradiol and progesterone on brain-gut interactions.…”

“…Midlife women between the ages of 40 and 65 typically experience multiple biological, psychological, and social challenges related to the transitions of menopause, development (i.e., re-discovering self) and situation (i.e., changing family relationships, re-balancing work and personal life) [ 1 – 3 ]. This is also a period when many women seek health care for gastrointestinal symptoms including abdominal pain/discomfort, intestinal gas, and alternations in bowel function such as diarrhea and constipation [ 4 – 7 ]. When no organic cause is found, they may be considered to have functional abdominal pain or irritable bowel syndrome (IBS).…”

“…For the most part, little is known about the experience of IBS during the midlife period and/or the menopausal transition. Among women with IBS, cross-sectional studies show either an increase in gastrointestinal symptom severity [ 4 ] or no difference when premenopausal women are compared with postmenopausal women [ 6 , 7 , 12 ]. One cross-sectional study reported less severe gastrointestinal symptoms but lower IBS-specific quality of life among midlife and older women with IBS compared to younger individuals [ 13 ].…”

Study of laxative and hepatoprotective activity of extracts obtained from Prunus domestica fruits

“…They are diagnosed in 35% of the adult population and in 3% of children who visit a doctor; and in 10-25% of patients with chronic diseases of the digestive system (Red`kin et al 2020). Pathogenesis and correction of constipation are of considerable scientific and practical interest, which is reflected in many modern publications (Ford et al 2018;Ballou et al 2019;Ford et al 2020;Lenhart et al 2020;Shin et al 2020) and in internationally agreed documents: Roman II, III, IV (1999,2006,2016) consensus, WGO: Practice Guideline: Constipation (OMGE2005, WCOG2017, WCOG2019). Therefore, the search for new laxatives of plant origin with a long and safe period of use is a topical issue in modern medicine.…”